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2. 
6. APPLICATION FOR WATER OR WASTE WATER SERVICE
   **MUST RETURN IN PERSON WITH PHOTO ID**
8. System
10. Parcel #*
    If your parcel number is unknown, look it up online prior to filling out this form.
11. Phone #*
13. Legal Owner*
14. Cell #*
16. Address*
17. Fax #*
19. City*
20. State*
21. Zip Code*
25. IF OCCUPANT OTHER THAN OWNER, LETTER FROM OWNER AUTHORIZING INSTALLATION/BILLING TO BE SENT TO OCCUPANT MUST BE ATTACHED. CURRENTLY ONLY CHECK, CASH, CASHIER CHECK OR MONEY ORDER ARE ACCEPTED FOR PAYMENT.
27. Occupant*
28. Phone #*
30. Address*
31. Cell #*
33. City*
34. State*
35. Zip Code*
37. Mailing Address*
39. Structure*

    1. Apartment
    2. Commercial

    1. Duplex
    2. Industrial

    1. Single Family
41. Signature of Owner / Occupant*
    *Must be signed by hand.
42. Date*
44. Amount Received
    N/A
45. Received By
47. NOTICE: COST OF INSTALLATION IS NOT COVERED BY PERMIT FEE.
    Installation cost will be billed when charges have been finalized.
51. The following information is required by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program.
    
    
    You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in anyway.
    
    However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.
53. Ethnicity

    1. Hispanic or Latino

    1. Not Hispanic or Latino
55. Race

    1. American Indian / Alaskan Native
    2. Asian
    3. Black or African American

    1. Native Hawaiian or Pacific Islander
    2. White
57. Sex

    1. Male

    1. Female
59. This institution is an equal opportunity provider.
    
    Esta institucion es de oportunidad igualada.
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